Forms and Payment

Appointment Scheduling and Cancellation Policies: Appointments may be made in person, over
the phone, or via email (this is the least recommended option however due to a little longer
response time with email). 50 minutes is considered a one hour appointment (25 minutes a half
hour). Appointments generally are made for one hour on the hour from 9am – 5pm (5pm being
the last appointment), unless a special arrangement is made.

If an appointment is missed, or canceled with less than 24 hours’ notice, you (not your insurance
company) may be charged the full fee for that missed session. Exceptions may be made if you
are sick or have an unavoidable emergency.

Payment Policy: We are committed to providing you with the best possible care. The fee for
service is $140.00 per 50 minute session ($70.00 for 25 minute session). Fees are due at the end
of the session and can be paid by check, cash and debit or credit card (we accept Visa, Master
Card and Discover – we do not accept American Express). Our policy on returned checks includes
an additional $25 office charge to be paid before your next appointment by cash, credit card or
money order.

A “no show” (a missed appointment where you failed to contact us within 24 hours of your
appointment) fee equivalent to your normal session fee will be charged (eg. if your normal
session fee for 1 hour is $140, then you be charged and billed $140). Only in the case of an
emergency will negotiating this fee be considered.

Any accounts 90 days past due will assessed 1.5% interest per month and may be turned over to
a collection agency. You will be required to pay the amount due plus any collection and/or
attorney fees.

Insurance Policy and Reimbursement: As fairly typical, Insurance filing is a courtesy extended
to you and not a requirement for Ms. Storen. All session fees and account balances are the sole
responsibility of the patient. We have limited our participation in managed care insurance plans
because we have found that the extraordinary amount time and resources required for paperwork,
telephone time, email traffic, meeting government regulations, etc. takes us away from out main
objective of providing you with the best patient care. We are also quite concerned by possible
intrusions into issues of confidentiality for our clients.

However, if you have medical insurance and it provides for mental health counseling, we support
your receiving the maximum allowable benefits. To assist you in that effort on a case by case
basis we can file a claim for you with your insurance carrier. You will need to contact your
insurance company yourself beforehand to see if you need pre-qualification or if they will cover
Ms Storen, and to what extent. There are so many different plans by so many different
companies it would be almost impossible for us to keep up with the specifics of each plan.

In summary, you would pay us directly at the time of your session and then we would generate
the required form and mail in to your insurance carrier for direct reimbursement to you. We will
need to make a copy of your insurance ID card to keep on file in order to submit a claim for you.
You will also need to sign a separate form allowing us to release information to your insurance
carrier (please see “psychotherapy notes” in our Privacy and HIPPA Policy – we do not submit
psychotherapy notes for an insurance claim, so the intimate details you discuss in session are not
shared with any insurance company).

For a full description of the PROFESSIONAL DISCLOSURE & POLICY STATEMENT, download the Client Intake Forms.Client Intake Forms

Please fill out the forms prior to your first visit. If you have any questions, please feel free to contact me.

Directions to Louisa Storen, LISW LMFT

At the stop light of SHELLMORE and HWY 17, turn right onto South Shellmore. Then turn left onto Johnnie Dodds Blvd ("frontage"
road). Once you turn onto S. Shellmore Dr. it is 0.3 miles until you come to the driveway entrance of Hobcaw
Professional Center. Now look for the driveway entrance to Hobcaw Professional Center. The
sign for Hobcaw will be to the right of the driveway and you'll drive a little past it. As soon as you pass
the sign turn in. This is the Hobcaw Professional Center. When you turn in here you'll be facing a two story
brick building. Drive around to the left of this building and keep going all the way to the back - you'll
be in the parking lot. After you pass the mail boxes on your right, turn right and you should be facing our
building which should be straight ahead. The numbers 757 are on the left of the building. We are downstairs
on the left side when you walk in the front door. Just come in!

Go through Anna Knapp intersection and look for next stop light. This will be DRAGOON DR. Turn left onto Dragoon Dr. (Verizon
Wireless will be on your left and 1 St Citizens Bank on your right) and then immediately turn right onto
Johnnie Dodds Blvd ("frontage" road). Once you turn onto Dragoon Dr. it is 0.2 miles until you come to the
driveway entrance of Hobcaw Professional Center. When you turn onto Johnnie Dodds you'll drive past BB&T
on your left, look for a Maxillofacial sign, the next driveway is where you'll turn in. This is the Hobcaw
Professional Center. It's sign is to the right of the driveway and isn't easily visible from this direction.
When you turn in here you'll be facing a two story brick building. Drive around to the left of this building
and keep going all the way to the back - you'll be in the parking lot. After you pass the mail boxes on your
right, turn right and you should be facing our building which should be straight ahead. The numbers 757 are
on the left of the building. We are downstairs on the left side when you walk in the front door. Just come
in!